Papers by Katherine Boothe
Canadian Journal of Political Science, 2013
This article investigates the limits that ideas place on the scope of policy expansion though an ... more This article investigates the limits that ideas place on the scope of policy expansion though an empirical puzzle: Canada lacks a nation-wide, universal pharmaceutical insurance program, which contrasts with the experience of most mature welfare states and Canada's own broad public hospital and medical insurance. The article find that ideas matter in policy development because of the mechanisms put in place by the pace of change. A slower, incremental process of policy development leads to restricted policy ideas that limit opportunities for program expansion. The article finds evidence of a reciprocal relationship between policy ideas and public expectations in four proposals for nation-wide pharmaceutical insurance in Canada between 1944 and 2002.
Journal of Health Politics, Policy and Law, Jan 1, 2012
When policy change is considered, what determines its success or failure? Why do plans for broad ... more When policy change is considered, what determines its success or failure? Why do plans for broad reforms often fall short, and why do certain types of change become more difficult over time? This article addresses these questions by examining health policy development in Canada, Australia and the UK -specifically, why Canada alone failed to adopt nation-wide, public pharmaceutical insurance. It demonstrates that the pace of change has significant implications for the scope of policy development. It provides new mechanisms to explain why incremental reforms stall based on the reciprocal relationship between elite ideas and public expectations, and suggests that similar factors can explain how barriers to policy change develop and the conditions under which barriers may be overcome.
Canada is the only OECD country that provides broad public health benefits but lacks a universal,... more Canada is the only OECD country that provides broad public health benefits but lacks a universal, nation-wide system for funding prescription drugs. This puzzle cannot be explained by the literature on national health insurance, which suggests that the tendency to consider all health services as a single policy has missed an important source of cross-national variation. How can we explain the lack of a major pharmaceutical program in Canada, in light of the country's own extensive health system and the experience of almost all other welfare states? More generally, why do some countries adopt universal, comprehensive pharmaceutical programs, while others do not?
The Open Health Services and Policy Journal, Jan 1, 2009
Drawing on international examples of published policy objectives for national pharmaceutical poli... more Drawing on international examples of published policy objectives for national pharmaceutical policies, we propose a framework for gauging system performance on the health-related goals of policy in the pharmaceutical sector. We review basic policy structures and performance indicators for the seven participating countries of the Commonwealth Fund"s 2007 International Health Policy Survey. We explore performance on three inter-related objectives that support overarching health goals: promoting the accessibility, appropriateness, and affordability of medicines. Indicators of performance along these dimensions are compared across countries and stratified by age, income and morbidity. Though no country appears uniformly strong in all areas, several appear to have done well to manage sometimes-difficult tensions in the pharmaceutical sector.
Value in Health, 2008
ined the impact of changes in private drug plan formulary design on the health of private plan be... more ined the impact of changes in private drug plan formulary design on the health of private plan beneficiaries. METHODS: A search of the medical literature was conducted using the PubMed search engine. Search terms included combinations of reimbursement, formulary, plan, payer, restriction, cost, and adherence. The 'related articles' feature in PubMed was also used to identify relevant papers. RESULTS: While no published studies of Canadian employer-sponsored drug plans were identified, there were 15 North American studies that focused on the effects of changes in drug plan design. This body of research demonstrated three key points. Cost-sharing initiatives resulted in a reduction, or complete cessation, of medication consumption, including drugs deemed "essential", and that decreased adherence to drug therapy can actually lead to the increased use of other more expensive health care resources. On the other hand, higher levels of medication adherence, which increased drug costs, were associated with lower overall health care costs. Employee satisfaction with their employer drug plan decreased when cost-containment measures were implemented and this is a problem for employers since drug plan changes typically involved increasing fees or imposing more restrictions to access. CONCLUSION: A shortterm focus on controlling drug costs is likely to have negative consequences on the health, productivity and satisfaction of plan members. If changes to drug plans are not properly assessed, there can be undesirable and expensive consequences for plan members and employers. Employers need a longer term framework to guide and support health plan decision-making that avoids sudden or drastic changes to health benefits. Careful consideration of drug plan design and cost-sharing can improve medication adherence, health outcomes, employee satisfaction, and costs.
Australian Prescriber, Jan 1, 2010
Australians and New Zealanders may see their systems for drug subsidy as different but, when view... more Australians and New Zealanders may see their systems for drug subsidy as different but, when viewed from the other side of the Pacific, important similarities emerge. 1 Both systems provide universal public subsidy to make commonly used medicines more accessible and ...
Journal of Comparative Policy Analysis: Research and Practice, Jan 1, 2009
This article seeks to explain why US environmental policy has increasingly focused on children&#x... more This article seeks to explain why US environmental policy has increasingly focused on children's environmental health while this frame has not had the same impact on either the political agenda or policy outputs in Canada. This contrast is striking since the literature on issue definition and agenda setting suggests that redefining environmental issues in terms of a valence issue like children's health should be a promising strategy for politicians in both countries. We argue that Canada's less enthusiastic embrace of children's environmental health is a function of the institutional context, in particular fewer opportunities for policy entrepreneurship in a parliamentary government than within the US separation of powers; distinctive policy legacies in the two countries that created an opportunity to advance children's environmental health in the US but deterred it in Canada; and different opportunity structures for non-governmental actors, which prompted US environmentalists to frame their campaigns in terms of children sooner than did their Canadian counterparts. The study illustrates the value of cross-national studies of agenda setting in highlighting the influence of political institutions on issue definition.
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Papers by Katherine Boothe